171 Club RERF18-0229 NOTICE OF COMMENCEMENT
pa,al RERF18-0229 T.Fo#oN.. J )0,2q&-06X0
shoul Florida county of —D��a
To whom it may,concern:
The undersigned hereby Inftmes you that Impronhanorms will be made W ommilm real property,and In
accordance with Section 713 of the Florida Statutes the folowfing Information Is abroad In this NOTICE OF
COMMENCEMENT.
Legal deacripthom off property being Ingtorved: 5-69 16-2S-29E ATLANTIC BEACH OR 16188-536
Ackfiresic4pro"belVin,moseck. 171 CLUB R
Atlantic Beach FL 32233
Remy
Owne".HUGHES BRIAN P
Address 171 r.1 I IR W Allant r.Reach FL 32213
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Fee Simple Titleholder Qfp1her owmer)
Name Z,*HeS
Address PXI L10 , PTU"Tilc
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S."(If any)
Athlete, ...........Annuumof bond$
Pin.No. Fax No.
Name and address of any phater,making a loan for Me construmtkat of the Impromements
Name
Md..
Phone No. Fax No.
Name of person wMin the State of Florida,other than himseff.dougnated by amer upon Mom notloser or other
documents,may be served:
Name
Address
Phorm No. Fax No
In addition to himself,owner designates the foSawang person to mcarba,a oopty of"Uences Notica,as Provided in
S�n 713.01(2)M).Floarda Statutes.(FBI ki at Ownees opgon).
No.
Address
Mom No. Fax No.
Exl*aWn data of Nonce Me expladhon date is one(1)youlaBran Me data of mounting urriess a
diffierent date is Wetted):
TIUS SPACE FOR RIECORDERPS,USE ONLY
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Recorded lWlZ'2Dl8 03:17 PWI.
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00
41;".Vw
=7d
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RERCOF SHINGLE -
MUST CALL BY 4PM FOR NEXr DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0229
Description:
Estimated Value: 10800
Issue Date: 9/14/2018
Expiration Date: 3/1312019
PROPERTY ADDRESS:
Address: 171 CLUB DR
RE Number: 1702460020
-�-R—OPERTY OWNER:
Name; HUGHES BRIAN P ET AL
Address: C/O HEEDE DAG 0171 CLUB DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies,or federal agencies.
* A notice of Commencement is only nquired for work exceeding an estimated value of
$2,500.For IIVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
Building Permit Application Updated IZ/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(504)247-5826 Fax:(904)247-5845
Job Address:.I- I C"IS Dgi VC– Permit Number
WdTay�-
Legal Description5-&q 14 -2 5-2?45 1-7 Z ATLAIVIIC 69�51+W o1i �AIWE#
Valuation of Work(Replacement Cost)$ 10,166 H.MdJC..IedSF_RIA_N..-Heawd/Cmied jJ/4r
' aWtAZeF5A-t�KLe"57
• Class of Work(Circle one): New Addition teratio Repair Mow Oemo Pool Winclow/Door
idential
• Use of existing/proposed structure(s)'Circle one): C mmercial <��_
• lfan eAsting structure,is afire sprinkler system installed?(Circle one): Yes��Il/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe In detail th ofwork to be performed, -nc
LA 1 9– S M 1(4 6 L05 A 14 D FL-L-r.Thi srfiab� iS K Um71J"'qe`T 6Ar
T`IA46eeLiA)6 '51A(NetLell "8AI!6itWOd0
Florida ProductApprowl#Fl-_101Ln11D 4AX-61""i 14-b for multiple products use product approval form
1. .I—-_07y�
pmp,rih,OWner Informed
Name-61i F. A4 6, 11eUtIF Address: #111 �L" Pe.
City ORTUIll MF40711 –State rt. Lp 32Z33 Phone –
E-Mail RelAnih) L_.914
Owner or Agent(IfAgent,Power of Attomey or Agency Letter Required)
Contractor infoMati2n CiWk)L-jL/8JA I LDt?R– AFPADAV IT'
Name of Company: Qualifying Agent:
Addres city state—ZIP_
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone Al
Workers Compensation Exempt/imurer/Lease E.PIM.,/sxpiratian Date
Application is hereby made to obtain a permit to do the work and installations as indicanted.I certify that no work or instal lation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws reffulationg
construction in this jurisdiction.I understand that a separate permit must be secured for ELECMICAL WORK,PWMBING,SIGNS,
WELLS,POO LS,F URNACES,BOILERS,HEATERS,TANKS,and AIR CON D7IONERS,etc.NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found In the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNEWS AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENT T Y U INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LEND ORA&ATTORNE E
kal.
REC7NG YOUR NOTICE OF COMMENCEMENT. -AN N
'(Ytgnature o ner or Agent) (Signature of Contractor)
d.jrfind. o.nbx�'.r)
Signed and sworn to(or affirme!before me t is 1�71 day of Signed and sworn to(or affirmed)before me this day of
fiff
2ft?jfby ur by
(�gjixture of Notary) (Signature of Notary)
I ]Personally Known I Personally Known OR
L),Produced Identification 11 1 Produced Identification
Type of Identificati.m: :��4�� — Type of Identification:
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTEB; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING'REQUIRES OVyNER/BUILDER TO ACKNOIALEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 489.103(l),FLORIDA STATUTES
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT RAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSM F YOUMAYBUILDORIMPROVEAGNE—OR.
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
"ROVE A 00MVIDERCIAL BUILDING AT A COST OF$25,O]OX OR LESS. THE BUILI)
MUST BE FOR YOUR USE AND OCCUPANCY. ITMAY NOT BE BUILTFOR SALE OR LEASE.
IF YOU S11,1, OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLEUS,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EMEPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOP, YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EIVIPLOYED BY YOU HAVE
LICENSES 9EMIRED BY STATE LAW AND By COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WTHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
114. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO S5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN-OCCUPATIONAL LICENSE'IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY' OR THE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5820)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
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ADDRE8Z PHONE NUMBER
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Nom,Pottle at urgit,State of
GUADALUPE GARCIA
Notary Public Slit,of Florida
cimundision A,RE 943675
My Call Expires DOC 15,2019
Notary Signaham: (� — ==
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